Putting healthy longevity before profits
Authors: None The Lancet Healthy Longevity
Journal: The Lancet Healthy Longevity (2023)

World No Tobacco Day, observed on May 31, was created by WHO, in 1987, to inform “the public on the dangers of using tobacco” and to raise awareness about “what people around the world can do to claim their right to health and healthy living and to protect future generations”. The harmful effects of smoking on human health and ageing are undeniable. Commercial interests in tobacco are directly at odds with the goal of achieving healthy longevity for all. As the Lancet Series on commercial determinants of health highlights, to prevent and reduce harms to human health, rethinking society's and individuals’ relationship with harmful products is imperative. Is economic growth worth achieving if it comes directly at the cost of human health and lifespan? In 2019, approximately 7·69 million deaths and 200 million disability-adjusted life-years (DALYs) were attributable to smoking tobacco use. Major smoking-related causes of death and disability include ischaemic heart disease; chronic obstructive pulmonary disease; tracheal, bronchial, and lung cancers; and stroke. Smoking is also an important risk factor for dementia and is strongly associated with frailty in middle-aged and older adults. Substantial efforts have been made to reduce smoking-related harms, and it is worth noting that progress has been made; between 1990 and 2019, smoking rates decreased by 27·5% in men and by 37·7% in women. Unfortunately, an increasing global population has offset these gains and, in 2019, the estimated number of current smokers worldwide was 1·14 billion people, compared with 0·99 billion in 1990. Additionally, improvements have been uneven. Of the 71 countries that recorded substantial increases in the proportion of all-cause deaths attributable to tobacco use between 1990 and 2019, 66 (93%) were low-income and middle-income countries. The WHO Framework Convention on Tobacco Control treaty was introduced in 2005. The 182 ratifying countries have agreed to implement several anti-tobacco measures, such as new taxation on tobacco products, advertising bans, public health campaigns, and smoking cessation programmes. However, despite almost global support for the treaty, adherence to its articles has not been absolute. The 2021 global progress report highlights that, although 85% of signatory countries have implemented article 8 (protection from exposure to tobacco smoke), only 13% have implemented article 17 (provision of support for economically viable alternative activities). Governments must commit to fully implementing all articles of the convention. Bold and decisive approaches, such as New Zealand's Smokefree Environments and Regulated Products Act, which prohibits selling or supplying smoked tobacco products to anyone born on or after Jan 1, 2009, are essential for the creation of a smoke-free generation. Evidently, tobacco is not the only industry whose commercial interests pose major obstacles to health and healthy ageing. Other industries highlighted in the Lancet Series include alcohol, ultra-processed foods, and fossil fuels. WHO estimate that the harmful use of alcohol caused 3 million deaths and 132·6 million DALYs globally in 2016. As with smoking, alcohol misuse is a risk factor for dementia. Ultra-processed foods, defined as those with formulations of ingredients, mostly of exclusive industrial use, that result from a series of industrial processes, are associated with high morbidity and mortality from cardiovascular disease, dementia, and other adverse health outcomes. The harms from fossil fuels come in many forms, from air pollution to the wider effects of climate change. Combatting the commercial determinants of health is not an easy task. The creation of the WHO Framework Convention on Tobacco Control treaty shows that impactful global harm-reduction strategies are possible, but implementation failures and the ongoing health burden of smoking underline the challenge of overcoming commercial interests. A formidable array of practices designed to protect these interests persists, such as advertising, reputation management, litigation, and lobbying by commercial entities. However, the Lancet Series outlines future directions to be taken to address the commercial determinants of health, including rethinking economic models that place growth at the cost of all else, government regulation, and strategic civil society mobilisation. As the authors argue, “the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort”. Commercial entities cannot be allowed to harm human health and longevity any longer.